Critical Care Exam 1 questions with
complete solutions
What are some common causes of pain in critically ill patients? - ANS ✔✔pain is very common
in critically ill patients; some common causes include:
-preexisting diseases and conditions
- invasive procedures
-trauma
-monitoring devices/tubes (catheters)
-nursing care (dressing changes, repositioning, etc.)
-immobility
What is the nurse's role in pain management? - ANS ✔✔nurses have the universal goal of
maintaining a level of comfort for their patients; it's important for nurses to assess and manage
the patients' pain appropriately; end goal is complete elimination of the pain, though it is not
always possible
patients may experience pain differently based on different psychological needs or cultural
values
What can problems can stem from unrelieved pain? - ANS ✔✔poor sleep, which can lead to:
-exhaustion
-disorientation
-anxiety
-agitation
-PTSD
,-PICS (post intensive care syndrome)
What is the definition of pain? - ANS ✔✔an unpleasant sensory and emotional experience
associated with actual or potential tissue damage; pain is always what the patient says it is (it's
subjective)
considered the "fifth vital sign"; nursing goal is to maximize patient comfort to avoid
complications such as sleep deprivation, agitation, PTSD; assessment and treatment plans
should include specific goals and outcomes
0-10 pain scale is gold standard when assessing pain; however, there are barriers to that pain
level that doesn't work for all patients such as altered communication and decreased level of
consciousness
What is the definition of anxiety? - ANS ✔✔prolonged state of apprehension in response to
fear; marked by apprehension, agitation, and autonomic arousal
like pain, anxiety levels are what the patient says they are; anxiety is not a benign state, and if
left unresolved it can lead to greater morbidity and mortality, especially in patients with
cardiovascular disease due to sympathetic nervous system arousal and the subsequent release
of catecholamines such as epinephrine and norepinephrine, which spikes vital signs, which can
be detrimental to cardiovascular patients
What is the relationship between pain and anxiety? - ANS ✔✔they exacerbate each other
(untreated pain leads to increased anxiety and vice versa); if left unresolved, the can lead to the
patient feeling powerless and displaying agitation and potentially delirium
they are interrelated and can be difficult to differentiate; they are also cyclic in nature
What are some predisposing factors of pain and factors that can influence pain perception? -
ANS ✔✔predisposing factors: disease, procedures, monitoring devices, nursing care, trauma
,factors that influence pain perception:
-expectation of pain (as a nurse, be honest about the pain they will experience and let them
know what they expect, ex: "this will hurt for a couple of minutes", etc.)
-previous pain experiences (can affect their expectation of pain, such as if they had a previous
nurse who took several tries to get their IV)
-emotional state
-cognitive status (can they understand what is happening?)
What are some predisposing factors of anxiety? - ANS ✔✔inability to communicate, noise, light,
excess stimulation
examples:
-endotracheal tube
-monitor alarms
-lack of mobility
-unfamiliar surroundings
-uncomfortable room temperatures
-sleep deprivation
What are some physiological effects of pain and anxiety?* - ANS ✔✔-raises catecholamines
(epi, norepi, dopamine - can stress the CV system, especially when patient is critically ill -->
vasoconstrictive effects in the alpha portion)
-interference with healing
-increased oxygen consumption (end-organ ischemia)
-increased respiratory effect and hyperventilation (respiratory alkalosis, which leads to impaired
tissue perfusion, which can become cyclic in nature)
, -fighting the ventilator/delay in ventilator weaning (can lead to increased feelings of
breathlessness - fighting the ventilator is called desynchrony, which can cause alveolar damage;
the ET tube creates a choking sensation)
-dyspnea (in vented patients and can go unrecognized by providers and nurses; treating the
patient with bronchodilators such as albuterol and adjustments in the vent settings may
improve pain and anxiety)
-constipation
-cool extremities
-diaphoresis
-hypertension (increases myocardial oxygen demand)
-increased cardiac output
-increased glucose production (gluconeogenesis)
-mydriasis (pupillary dilation)
-nausea
-pallor and flushing
-sleep disturbance
-tachycardia
-tachypnea (rapid breathing requires a lot of effort and use of the accessory muscles)
-urinary retention
*in a healthy amount, pain and anxiety can increase performance levels, such as in flight-or-
fight response
What are some psychological effects of pain and anxiety? - ANS ✔✔-panic and fear
-agitation
-lack of sleep, nightmares
-delirium (untreated can lead to increased mortality)
-isolation, loneliness
complete solutions
What are some common causes of pain in critically ill patients? - ANS ✔✔pain is very common
in critically ill patients; some common causes include:
-preexisting diseases and conditions
- invasive procedures
-trauma
-monitoring devices/tubes (catheters)
-nursing care (dressing changes, repositioning, etc.)
-immobility
What is the nurse's role in pain management? - ANS ✔✔nurses have the universal goal of
maintaining a level of comfort for their patients; it's important for nurses to assess and manage
the patients' pain appropriately; end goal is complete elimination of the pain, though it is not
always possible
patients may experience pain differently based on different psychological needs or cultural
values
What can problems can stem from unrelieved pain? - ANS ✔✔poor sleep, which can lead to:
-exhaustion
-disorientation
-anxiety
-agitation
-PTSD
,-PICS (post intensive care syndrome)
What is the definition of pain? - ANS ✔✔an unpleasant sensory and emotional experience
associated with actual or potential tissue damage; pain is always what the patient says it is (it's
subjective)
considered the "fifth vital sign"; nursing goal is to maximize patient comfort to avoid
complications such as sleep deprivation, agitation, PTSD; assessment and treatment plans
should include specific goals and outcomes
0-10 pain scale is gold standard when assessing pain; however, there are barriers to that pain
level that doesn't work for all patients such as altered communication and decreased level of
consciousness
What is the definition of anxiety? - ANS ✔✔prolonged state of apprehension in response to
fear; marked by apprehension, agitation, and autonomic arousal
like pain, anxiety levels are what the patient says they are; anxiety is not a benign state, and if
left unresolved it can lead to greater morbidity and mortality, especially in patients with
cardiovascular disease due to sympathetic nervous system arousal and the subsequent release
of catecholamines such as epinephrine and norepinephrine, which spikes vital signs, which can
be detrimental to cardiovascular patients
What is the relationship between pain and anxiety? - ANS ✔✔they exacerbate each other
(untreated pain leads to increased anxiety and vice versa); if left unresolved, the can lead to the
patient feeling powerless and displaying agitation and potentially delirium
they are interrelated and can be difficult to differentiate; they are also cyclic in nature
What are some predisposing factors of pain and factors that can influence pain perception? -
ANS ✔✔predisposing factors: disease, procedures, monitoring devices, nursing care, trauma
,factors that influence pain perception:
-expectation of pain (as a nurse, be honest about the pain they will experience and let them
know what they expect, ex: "this will hurt for a couple of minutes", etc.)
-previous pain experiences (can affect their expectation of pain, such as if they had a previous
nurse who took several tries to get their IV)
-emotional state
-cognitive status (can they understand what is happening?)
What are some predisposing factors of anxiety? - ANS ✔✔inability to communicate, noise, light,
excess stimulation
examples:
-endotracheal tube
-monitor alarms
-lack of mobility
-unfamiliar surroundings
-uncomfortable room temperatures
-sleep deprivation
What are some physiological effects of pain and anxiety?* - ANS ✔✔-raises catecholamines
(epi, norepi, dopamine - can stress the CV system, especially when patient is critically ill -->
vasoconstrictive effects in the alpha portion)
-interference with healing
-increased oxygen consumption (end-organ ischemia)
-increased respiratory effect and hyperventilation (respiratory alkalosis, which leads to impaired
tissue perfusion, which can become cyclic in nature)
, -fighting the ventilator/delay in ventilator weaning (can lead to increased feelings of
breathlessness - fighting the ventilator is called desynchrony, which can cause alveolar damage;
the ET tube creates a choking sensation)
-dyspnea (in vented patients and can go unrecognized by providers and nurses; treating the
patient with bronchodilators such as albuterol and adjustments in the vent settings may
improve pain and anxiety)
-constipation
-cool extremities
-diaphoresis
-hypertension (increases myocardial oxygen demand)
-increased cardiac output
-increased glucose production (gluconeogenesis)
-mydriasis (pupillary dilation)
-nausea
-pallor and flushing
-sleep disturbance
-tachycardia
-tachypnea (rapid breathing requires a lot of effort and use of the accessory muscles)
-urinary retention
*in a healthy amount, pain and anxiety can increase performance levels, such as in flight-or-
fight response
What are some psychological effects of pain and anxiety? - ANS ✔✔-panic and fear
-agitation
-lack of sleep, nightmares
-delirium (untreated can lead to increased mortality)
-isolation, loneliness
